The quality of written communication between psychiatrists and general practitioners has become increasingly important, with the introduction of the Access to Health Records Act as well as with demands placed by the purchasers of psychiatric services. We investigated if a hospital-based audit could be used to monitor the quality of written communications with general practitioners, and if ‘closing the audit loop’ could improve the standards. We found that audit may have helped improve standards, particularly in making letters less potentially offensive and easier to read by non-psychiatrists. A method of measuring the quality of letters is described.

A model psychotherapy service is proposed, integrated in the double sense of combining different psychotherapeutic modalities in a single psychological treatment service, and forging close links with general psychiatry. The four limbs of the service extend into supporting counsellors in general practice, providing psychotherapeutic input into the treatment of the severely mentally ill, managing patients with personality disorders, and supplying psychotherapeutic aspects of a liaison service. The advantages of this model in the current managerial climate are discussed.

Assessment of patients referred for psychotherapy has more commonly consisted of a psychodynamic assessment with less emphasis on a formal psychiatric diagnosis, whereas the reverse tends to be the case in the general psychiatric services. Within the National Health Service there are close links between the two services. A common frame of reference regarding the definition of the patient groups using the services could Improve communication, the planning and evaluation of specific treatment programmes, and outcome studies. A retrospective case-note study was carried out at a regional psychotherapy unit in order to define the population referred between 1991 and 1992 according to ICD–10 (WHO, 1992).

A pharmacy-run lithium clinic was set up In a district general hospital in order to save medical staff time, utilise pharmacist skills and provide an efficient lithium monitoring service. After one year the clinic was evaluated in terms of the control of serum lithium levels, the acceptability of the arrangements to the patients and the patients' knowledge of and attitude towards lithium therapy. We suggest this model of a lithium clinic could be usefully adopted In other psychiatric departments.

Staff in nursing homes specialising in the care of the elderly mentally ill were trained to screen for psychiatric morbidity by members of the local psychogeriatric service. They were then involved in the planning and delivery of appropriate treatment, both medical and behavioural. Residents in the homes were screened again six months later and marked reduction in morbidity was found.

Registered care homes have been developed in Newham, a deprived inner city borough of about 220000 population, by a number of different housing associations. Some of these provide the care component themselves while others purchase it from separate agencies. The formats of the homes also vary. Features common to all the provision include prolonged preparation of future residents in rehabilitation houses on the Goodmayes Hospital campus prior to taking up residence, particular attention to their compatibility and social networks, and regular individual reviews by a community rehabilitation team which also provides training and support to care staff.

Resettlement of 15 long-stay psychiatric in-patients from a hospital rehabilitation unit to a new hostel was assessed by measuring symptoms, social behaviour and client satisfaction beforehand, then six and 12 weeks afterwards. Three residents experienced relapses with varying degrees of recovery. Overall, symptoms and social behaviour improved significantly. Change in satisfaction with the services offered proved difficult to measure accurately. A well resourced resettlement project can enhance long-stay patients' well-being.

Three hundred randomly selected fund-holding general practitioners were sent a questionnaire that asked them to indicate their priorities for child mental hearth services. They were also asked to rate their local child mental health services; 210 (70%) returned completed questionnaires. Items accorded the highest priority by the largest number of GPs included written communication, short waiting time following referral, sensitivity to patient's cultural background, child sexual abuse services, and mental handicap services. Child psychiatrists were seen as the most essential members of multidisciplinary teams, and family therapy was the most popular choice of treatment. Financial considerations did not appear to dictate GPs' choices. About half of respondents rated their local services as barely satisfactory, unsatisfactory or extremely unsatisfactory.

Recent studies have highlighted deficiencies in ECT service delivery. This audit was set up to monitor and improve the ECT administered in a large psychiatric service. In the first phase of the audit Information was collected regarding stimulus adjustment in response to brief seizures. This highlighted inconsistencies In clinical practice and an education programme was instigated to correct these deficiencies and to bring practice into line with the Royal College of Psychiatrists guidelines. A repeat audit was performed and a marked improvement in the quality of stimulus adjustment was shown.

Previous studies have demonstrated high rates of non-attendance among new referrals to psychiatric out-patient clinics. Consistent factors which distinguish non-attenders have not been shown. Forgetting an appointment contributes towards non-attendance and offers potential for its reduction. The effect of sending patients an appointment reminder three working days prior to the appointment date was examined. The rate of attendance of those sent a reminder improved significantly.

The differences in attitudes to their illness between selected groups of medical and psychiatric in-patients admitted to units on the same hospital site were investigated. Patients new to the services were asked about their willingness to disclose information about their admission to hospital and their diagnosis to family members, friends and people at work. Psychiatric patients were more likely to want to keep their admission and diagnosis a secret. They were also less sure of the nature of their diagnosis and the necessity of their admission. The results suggest that wider public education is needed to reduce the stigma of mental Illness.

In this paper the ethical concept of competence is explored in the context of a very challenging child psychiatry case. Both mental disorder and immaturity may impair a child's competence. However, It is emphasised that competence Is not a generic quality but one that should be applied to specific decisions, even when working with children.

There have been a number of recent changes in mental health care legislation in Australia some of which mirror the changes that have occurred in the UK. These are reviewed within the context of the differing health care system in Australia and with particular reference to the State of New South Wales.

Community mental health services have been criticised for seeing those with minor psychiatric disorders at the expense of those with severe and long-term illness. We report a cross-sectional evaluation of a UK service based entirely within the community. Most patients in contact with the service (66%) had a psychotic disorder or an affective disorder. Patients with greater impairment were likely to receive more intensive treatment. Only 20% of the community psychiatric nurse (CPN) case load focused on acute distress and neurotic disorders. Within this service careful operational planning and maintaining CPNs within the secondary care system appear to be critical factors in achieving the goal of giving priority to the severely mentally ill.

An attempt to categorise the nature of the work done by an inner city crisis intervention service (CIS) which is part of a comprehensive community mental health service is described. The work of the CIS as it relates to models of crisis intervention recognised in the literature is outlined. The role of this CIS in providing additional intermittent support to individuals receiving long-term community care is commended.

The case-notes of all patients in a district general adult psychiatric unit were assessed for standards of recording selected key items. The results were presented at a departmental audit meeting, and the assessment repeated after four months. Initial audit revealed poor standards of notekeeping in certain areas. On repeat assessment, standards of documentation had improved for all the key items assessed, and reached statistical significance for physical examination. This audit was quick, easy and cheap, revealed unexpectedly poor standards of notekeeping, and evidently produced a measurable and significant improvement in practice.

Opinions on the value of measuring tricyclic plasma levels vary substantially. In the United States, plasma levels of several tricyclics are frequently used to ‘optimise’ therapy. In the UK, plasma level monitoring is less often undertaken and measured levels are more usually used simply to assure compliance rather than as a guide to dose adjustment.

Substantial changes are taking place to undergraduate psychiatric curricula, in response to recent General Medical Council recommendations. The overall aim is to provide a training in core knowledge and skills that enables students to become competent junior house officers. These developments will inevitably affect clinicians' involvement in undergraduate teaching. How change is being implemented in Nottingham –and the success and challenges so far – is discussed.

This paper examines the concept of the person as distinct from the concept of the human being. It argues that the criteria which some contemporary philosophers propose for making this distinction are likely to have adverse effects for the moral status of people with learning disability and psychiatric disorders respectively.

The psychopathology of 20 subjects who presented to psychiatrists with facial dysmorphophobia was examined. Seven had body dysmorphic disorder and 13 had dysmorphophobic symptoms secondary to an underlying psychiatric disorder (usually depression). The body dysmorphic group had a younger age of onset and overvalued ideas about their appearance. In both groups there was a high proportion of associated personality disorder, usually of the anxious (avoidant) type.